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Öğe Advanced alveolar echinococcosis disease associated with Budd Chiari syndrome(International Journal of Surgery Case Reports, 2015) Soyer, Vural; Ara, Cengiz; Yaylak, Faik; Sarıcı, Barış; Özsoy, Mustafa; Koç, OkayINTRODUCTION: Alveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd–Chiari syndrome. PRESENTATION OF CASE:In this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd–Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images. DISCUSSION: Initially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients. CONCLUSION: The importance of early diagnosis to prevent advanced complications such as development of Budd–Chiari syndrome and metastasis has been underlined. © 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/4.0/).Öğe Advanced alveolar echinococcosis disease associated with Budd Chiari syndrome(International Journal of Surgery Case Reports, 2015) Soyer, Vural; Ara, Cengiz; Yaylak, Faik; Sarıcı, Kemal Barış; Özsoy, Mustafa; Koç, Okay; Yılmaz, SezaiAlveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd–Chiari syndrome. PRESENTATION OF CASE:In this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd–Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images. DISCUSSION: Initially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients. CONCLUSION: The importance of early diagnosis to prevent advanced complications such as development of Budd–Chiari syndrome and metastasis has been underlined.Öğe Advanced alveolar echinococcosis disease associated with Budd-Chiari syndrome(Elsevier Sci Ltd, 2015) Soyer, Vural; Ara, Cengiz; Yaylak, Faik; Sarici, Baris; Ozsoy, Mustafa; Koc, Okay; Yilmaz, SezaiINTRODUCTION: Alveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd-Chiari syndrome. PRESENTATION OF CASE: In this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd-Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images. DISCUSSION: Initially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients. CONCLUSION: The importance of early diagnosis to prevent advanced complications such as development of Budd-Chiari syndrome and metastasis has been underlined. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.Öğe Comparison of Two Pancreatic Anastomosis Techniques in terms of Postoperative Complications After Pancreaticoduodenectomy(Aves, 2021) Koc, Suleyman; Dirican, Abuzer; Soyer, Vural; Ara, Cengiz; Yologlu, Saim; Yilmaz, SezaiObjective: in this retrospective study, we compared the postoperative complications by using both the Clavien-Dindo classification and the Revised 2016 International Study Group on Pancreatic Surgery (ISGPS) classification methods after pancreaticoduodenectomy. Materials and Methods: The data of patients were retrospectively reviewed. Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) were performed on 41 and 40 patients, respectively. The patients were assigned into two groups for anastomosis types and compared with each other according to postoperative complications. The postoperative follow-up period of the patients was limited to 90 days. Results: No significant difference was detected between the two groups in terms of gender (P = 581) and age (P = .809). According to the Clavien-Dindo classification system, grade I complication rates were 29.3% and 35.0% in. PJ and PG groups. respectively. Also, grade 2 complication rates were 34.1% and 325% in PJ and PG groups, respectively. Besides, grade 3B complication rates were 9.8% and 17.5% in PJ and PG groups, respectively. No grade 3A, grade 4A, and grade 4B complications were detected in both groups. But, grade 5 complications rates were 2.4% and 5.0% in 11 and PG groups, respectively. Based on the ISGPS classification system, the pancreatic fistulas were classified. The biochemical leak rates were calculated as 26.8% and 37.5% in PJ and PG groups, respectively. The rates were 14.6% and 10% in PJ and PG groups, respectively, for grade B complications. Also, grade C complication rates were 9.75% and 115% in. PJ and PG groups, respectively. No statistically significant differences were detected between the two groups for postoperative complications. Conclusion: The evidence from this retrospective study suggests that there is no difference between the two types of pancreatic anastomosis techniques (PJ or PG) in terms of the rate of postoperative complications.Öğe Corona mortis in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair(Hernia, 2015) Ateş, Mustafa; Kınacı, Erdem; Köse, Evren; Soyer, Vural; Sarıcı, Kemal Barış; Çuğlan, Songül; Korkmaz, Mehmet Fatih; Dirican, AbuzerPurpose Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated. Materials The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated. Results Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (C2 mm) or thin (\2 mm). Injury of arterial CMOR during tack stapling on Cooper’s ligament was seen in six cases (1.5 %). All of them were thin (\2 mm) in structure. Venous CMOR was visible only under low pressure in work space. Conclusion During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper’s ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (\2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.Öğe Dev peritoneal mezotelyal kist literatür eşliğinde olgu sunumu(Causapedia, 2015) Sarıcı, Kemal Barış; Soyer, Vural; Onur, Asım; Dirican, Abuzer; Ünal, BülentMezenterik kistler (MK) çok iyi prognoza sahip, nadir görülen genellikle benign karakterde intraabdominal kistik kitlelerdir. Bir kaç mm ile 40 cm arasında değişir. Belli boyuta gelinceye kadar asemptomatik olması ve spesifik bir semptomunun olmamasından dolayı preoperatif doğru tanı koymak gecikebilir. Bu yazımızda, karın ön duvarındaki peritondan kaynaklanan basit bir MK olgusu sunuldu. Elli bir yaşında erkek hasta 4-5 aydır devam eden karında şişlik ve ağrı şikayeti ile kliniğimize başvurdu. Özgeçmiş ve soygeçmiş sorgulamasında önemli bir özelliğe rastlanmadı. Rutin laboratuvar tetkikleri normaldi. Bilgisayarlı abdomen tomografisinde yaklaşık 12x10x11,5 cm boyutta, hafif yoğun içerikli ve düzgün sınırlı kistik lezyon görülüyordu. Kist hidatik serolojisi negatif geldi. MK ön tanısı ile göbek üstü median kesi ile laparotomi yapıldı ve eksplorasyonda sol üst kadran karın ön duvarı ve diyafragma üzerindeki pariyetal peritondan kaynaklı yaklaşık 12 cm çapında kistik lezyon olduğu görüldü. Total eksize edildi. Histopatolojik tanı multiloküle peritoneal inklüzyon kisti olarak rapor edildi. Karın ön duvarından kaynaklı peritoneal basit MK’ler oldukça nadir görülmekle beraber intraabdominal kistik kitle düşünülen hastaların ayırıcı tanısında akılda tutulmalıdır.Öğe Emergency Liver Resection with Staplers for Spontaneous Liver Haemorrhage in a Patient Receiving Anticoagulant Therapy(Hindawi Ltd, 2013) Kutluftirk, Koray; Soyer, Vural; Dirican, Abuzer; Unal, Bulent; Aydin, Cemalettin; Kayaalp, Cuneyt; Yilmaz, SezaiIntroduction. Emergency liver resection during active bleeding in a patient who takes anticoagulant therapy is a complicated and high-risk surgery. Aim. We described a technique that is combination of staplers, total hepatic vascular occlusion, and hemostatic agent (TachoSil) application for safe and quick hepatectomy. Patient and Method. A 72-year-old woman who uses warfarin regularly due to valvuloplasty admitted emergency unit with abdominal pain and shock. At admission, her hemoglobin, hematocrit, and INR values were 5.2g/dL, 14.9%, and 6.7, respectively. Radiologic evaluation revealed abdominal free fluid and a liver lesion on segments V, VI, and VII. Emergency laparotomy was required. There was an active bleeding from a liver hematoma that could not be controlled by packing, and an urgent hepatic resection was required. Under total hepatic vascular occlusion, segments V, VI, and VII were resected with endoscopic nonvascular staplers. Cut surface of the liver was coagulated with bipolar cautery and covered with a hemostatic material. Results. Hepatectomy took six minutes, and the duration of surgery was 80 minutes. There was no complication and no transfusion required after surgery, and the patient was discharged on 8th day, uneventfully. Conclusion. Emergency hepatectomy with staplers, under vascular control with hemostatic agents, provided a rapid and safe surgery.Öğe Futility versus acceptability of the use of grafts taken from end of line in the national organ sharing network(Transplantation Proceedings, 2015) Soyer, Vural; Koç, Süleyman; Onur, Asım; Sarıcı, Kemal Barış; Kayaalp, Cüneyt; Işık, Burak; Ünal, Bülent; Yoloğlu, Saim; Yılmaz, SezaiBackground. The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution. Methods. The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed. Results. A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively. Conclusions. The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.Öğe Futility versus acceptability of the use of grafts taken from end of line in the national organ sharing Network(Transplantation Proceedings, 2015) Soyer, Vural; Koç, Süleyman; Onur, Asım; Sarıcı, Kemal Barış; Kayaalp, Cüneyt; Işık, Burak; Ünal, Bülent; Yoloğlu, Saim; Yılmaz, SezaiBackground. The number of suitable donors for organ transplantation is limited in many countries. This limitation can be overcome with the use of organs removed from marginal donors (expanded-criteria donors [ECDs]). We examined the long-term results of 187 patients who underwent marginal cadaveric liver transplantation in our institution. Methods. The data of patients who underwent cadaveric liver transplantation from January 2007 to April 2014 were retrospectively reviewed. ECDs were evaluated by considering 19 internationally accepted criteria. The clinical data of recipients including age, clinical status, and Model for End-Stage Liver Disease (MELD) score were also assessed. Results. A total of 287 patients underwent cadaveric liver transplantation. A graft from an ECD was used in 181 (63.06%) patients. The mean MELD score was 18.8. In all, 45 patients (24.86%) underwent transplantations for fulminant liver failure and 136 patients (75.14%) underwent transplantations for other chronic conditions. The majority of donors died of cerebrovascular disease and trauma. Only hypotension requiring inotropic drugs and obesity significantly affected survival. The 90-day and 12-month survival rates of the recipients who received a graft from an ECD were 51.93% and 46.2%, respectively. Conclusions. The use of ECD allografts immediately and significantly expands the existing donor pool. Because of persistent organ scarcity, pressure to use a greater proportion of the existing donor pool will continue to increase.Öğe Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplant: Single Center Experience(Baskent Univ, 2021) Koc, Suleyman; Akbulut, Sami; Soyer, Vural; Yilmaz, Mehmet; Barut, Bora; Kutlu, Ramazan; Yilmaz, SezaiObjectives: In this study, we share our approach for care of patients with hepatic venous outlet obstruction after living-donor liver transplant. Materials and Methods: We retrospectively examined the demographic, clinical, and radiologic data of 35 patients who developed hepatic venous outlet obstruction after living-donor liver transplant. Patients were subgrouped on the basis of onset (8 patients with early onset [< 30 days post-transplant] and 27 patients with late onset [>= 30 days posttransplant]) and postoperative survival (24 survivors, 11 nonsurvivors). Results: Patients ranged in age from 1 to 61 years (24 adults and 11 children). All adult patients had undergone right lobe living-donor liver transplant. In the pediatric group, 8 had undergone left lateral segment and 3 had undergone left lobe living-donor liver transplant. Nineteen adult patients and all 11 pediatric patients underwent hepatic venous reconstruction, with all procedures based on common large-opening drainage models using various vascular graft materials. Development of hepatic venous outlet obstruction occurred at mean posttransplant day 233 +/- 298.5 in the adult patients and mean posttransplant day 139 +/- 97.8 in the pediatric patients. After development of obstruction, the patients underwent 1-6 sessions (1.5 +/- 1.1 sessions) of balloon angioplasty. After the first balloon angioplasty procedure, 25% of the adults and 36.3% of the pediatric patients developed recurrence. The early-onset and late-onset subgroups showed statistically significant differences in serum albumin (P=.01), underlying causes (P<.001), time from transplant to obstruction (P=.02), and time from transplant to last visit (P=.02). The survivor and nonsurvivor subgroups showed statistically significant differences in total bilirubin (P=.03) and time from transplant to last visit (P=.03). Conclusions: Common large-opening reconstruction minimizes hepatic venous outlet obstruction development after living-donor liver transplant. Balloon angioplasty and/or stenting is almost always the first option in the care of this complication.Öğe Hybrid Transvaginal Incisional Hernia Repair(Mary Ann Liebert, Inc, 2014) Kayaalp, Cuneyt; Yagci, Mehmet Ali; Soyer, VuralAim: Natural orifice translumenal endoscopic surgery (NOTES (R); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) is a new approach that allows surgical manipulations and specimen extractions through the natural orifices such as the vagina. There have been limited numbers of cases about the adaptation of NOTES for ventral hernia repairs. Here, we aimed to present two more cases and highlight our technical differences compared with the previously reported instances. Patients and Methods: Two patients (43 and 46 years old; body mass index of 29 and 30 kg/m(2), respectively) were treated with hybrid transvaginal incisional hernia repairs. Two 5-mm abdominal trocars were used to monitor transvaginal access, adhesiolysis, dissection of the hernia, and tuckering of the mesh. A 15-mm transvaginal trocar was used for scope and mesh introduction into the abdomen. Defects were 3-5 cm in diameter. Results: A rigid 5-mm laparoscope was used. The composite synthetic meshes were, respectively, 11 and 13 cm in diameter. These were passed through the vagina without any protection such as a bag or sheath. No conversion or additional port was required. Respective operative times were 120 and 180 minutes, and the patients were discharged uneventfully on the second day. One patient had seroma, which was managed conservatively (aspiration of 20 mL on Day 7). There were no recurrences after 7 and 13 months, respectively. Conclusions: Conventional laparoscopic equipment can be used for hybrid transvaginal incisional hernia repair. An anti-adhesive synthetic mesh can be inserted through the vaginal trocar without protective devices. The main advantage of this technique is to avoid 10-15-mm abdominal trocars, which increase the risk of trocar-site hernias themselves.Öğe Intraoperative Vasculer Complications in Living Donor Right Hepatectomy(Lippincott Williams & Wilkins, 2015) Dirican, Abuzer; Soyer, Vural; Sarici, Baris; Ates, Mustafa; Ozdemir, Fatih; Koc, Suleyman; Yilmaz, Sezai[Abstract Not Available]Öğe Laparoscopic and natural orifice transluminal restorative proctocolectomy: no abdominal incision for specimen extraction or ileostomy(Termedia Publishing House Ltd, 2016) Kayaalp, Cuneyt; Yagci, Mehmet Ali; Soyer, VuralThe aim of this study was to demonstrate the feasibility of laparoscopic restorative proctocolectomy (LRPC) without additional abdominal incisions. Two sisters with familial adenomatous polyposis were enrolled. The colon and rectum were mobilized entirely through the five abdominal trocars. The terminal ileum and distal rectum were transected with endoscopic staplers. The entire colorectal specimen was extracted transanally. A circular stapler anvil was introduced transanally. The-J-pouch was created intracorporeally. The rectal stump was re-closed and a pouch-anal anastomosis was created using a circular stapler. We used a transanal tube for decompression of the pouch instead of a diverting ileostomy. The patients were discharged on the 10th and 12th days uneventfully. Both were doing well with their pouches after 18.5 and 12.1 months of follow-up. With the help of transanal specimen extraction and transanal tube decompression, additional abdominal incisions can be avoided following LRPC.Öğe Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy(Aves, 2016) Kayaalp, Cuneyt; Soyer, Vural; Ersan, Veysel; Aydin, Cemalettin; Karagul, ServetCongenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.Öğe Life-Threatening Near-Miss Complications of Donor in Living Donor Liver Transplantation(Lippincott Williams & Wilkins, 2015) Onur, Asim; Dirican, Abuzer; Soyer, Vural; Sarici, Baris; Koc, Suleyman; Ates, Mustafa; Koc, Cemalettin[Abstract Not Available]Öğe Liver transplantation with livers from octogenarians and a nonagenarian(Transplantation Proceedings, 2015) Dirican, Abuzer; Soyer, Vural; Koç, Süleyman; Yağcı, Mehmet Ali; Sarıcı, Kemal Barış; Onur, Asım; Ünal, Bülent; Yılmaz, SezaiIntroduction. A shortage of deceased donors has compelled the use of extended-criteria donor organs in liver transplantation. The purpose of this study was to evaluate the impact of using deceased donors older than 80 years. Materials and Methods. We retrospectively evaluated 13 patients who received a liver graft from cadaveric donors older than 80 years between December 2007 and March 2014. We analyzed the donor and their recipient characteristics together with morbidity and mortality of recipients. Results. All 13 donors were older than 80 years (median age, 82.7; range, 80e93). There were 9 male and 4 female recipients with an average age of 50.7 (range, 2e65) years. All of the recipients did not have a living donor for liver transplantation. Recipients’ mean model for end-stage liver disease (MELD) score was 14.2 (range, 7e20). Graft with macroscopic steatosis was not accepted. Medium follow-up was 19.5 months. The most frequent cause for liver transplantation (LT) was hepatitis B virus (HBV) cirrhosis (8/13 patients). We had 1 case of primary nonfunction, and 4 patients died in 2 weeks after surgery. Of these patients, 2 of them received a split transplant from an 80-year-old cadaver liver. Overall the survival rate after 1 year was 61.5%. Conclusions. Deceased elderly donor usage in LT could expand the donor pool. Liver grafts from donors older than 80 years can be used in necessity or emergency situations. However, care should be taken to avoid early mortality and primary nonfunction. Procedures extending cold ischemia time such as split liver transplantation may increase the risk of primary nonfunction.Öğe Multiple renal arteries in patients with kidney transplantation initial experiences of the new kidney transplant center(Fırat Tıp Dergisi, 2015) Usta, Sertaç; Soyer, Vural; Sarıcı, Kemal Barış; Pişkin, Turgut; Ünal, BülentObjective: Multiple renal artery grafts of kidney transplant patients developing complications and results for long-term kidney function were evaluated. Material and Method: From 2010 to 2014, 115 kidney transplant patients were evaluated retrospectively. A sum of, 115 donor nephrectomies were performed in our instution. Kidney were transplanted with a single artery to 99 patients and sixteen (approximate 14%) with more than one. For five of these 16 patients, the organs were transplanted from a cadaver and eleven were transplanted from living donors. Results: Mean age was 38,5 years (range 9–58 years), mean follow up time was 22,5 month (min. 3,5 and max. 41 month) and mean cold ischemia time was 153 minutes for living donor transplantations and 1396 minutes for cadaveric transplantation, and also warm ischemia time was 236 seconds for living donor transplantation. In all cases, the grafted kidney began to function immediately after reperfusion. Fourteen of the recipients had no any early kidney dysfunction, a problem that is usually attributed to prolonged anastomosis time. Conclusion: Transplanting kidneys with multiple renal arteries may result in significant risks. Prolonged cold or hot ischemia time may elevate incidence of non functional graft and rejection. Results of this study points that unifying artery anastomosis at the backtable would reduce the risk.Öğe A pancreatic pseudopapillary tumor enucleated curatively(Elsevier Sci Ltd, 2015) Karakas, Serdar; Dirican, Abuzer; Soyer, Vural; Koc, Suleyman; Ersan, Veysel; Ates, MustafaINTRODUCTION: Pseudopapillary tumors (PPT) of the pancreas are very rare, comprising 0.3-2.7% of all pancreatic tumors, and they occur mostly in young women. Generally, they are benign, but in rare cases they can enlarge, invade adjacent organs, and metastasize distantly. Radiological assessments and biochemical markers are important for diagnosing tumor characteristics. The main treatment is tumor resection. PRESENTATION OF CASE: An 18-year-old female was referred to our department suffering from abdominal discomfort and upper quadrant abdominal pain. Abdominal computed tomography (CT) revealed a 6-x5-cm mass between the pancreatic head and right adrenal gland (Fig. 1). The histological assessment was a solid PPT of the pancreas with intact surgical borders. DISCUSSION: PPT are very rare, comprising approximately 5% of cystic pancreatic tumors and similar to 1% of exocrine pancreatic neoplasms and present mainly during the second and third decades of life. PPTs are usually indolent tumors. As such, they tend to produce vague nonspecific symptoms or may be detected incidentally on imaging. Complete surgical resection (R0) is the most effective therapy for PPT. CONCLUSION: Although PPT is a very rare, benign tumor, it has the potential to metastasize to adjacent and distant organs. Consequently, they should be detected early, so that they can be treated surgically before malignant conversion. (C) 2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd.Öğe Persistan hiperparatiroidiye neden olan intratimik paratiroid adenomu olgu sunumu(Causapedia, 2015) Sarıcı, Kemal Barış; Soyer, Vural; Ünal, Bülent; Koç, Süleyman; Onur, Asım; Dirican, AbuzerPrimer hiperparatiroidide (PHP) en sık etyolojik faktör, ektopik olarak yerleşimde gösterebilen soliter paratiroid adenomudur. Daha önce iki kere paratiroid adenomu nedeni ile opere edilmiş, kan kalsiyum ve parathormon düzeyi yüksekliği devam eden 63 yaşındaki kadın hasta sunuldu. Adenomun preoperatif tc99-MIBI sestamibi ile parajuguler yerleşimi tespit edildi ve intraoperatif gamma prob kullanıldı. Radyoaktivitenin en yüksek olduğu lokalizasyon intratimik bölge idi. Timus ile birlikte adenom eksizyonu yapıldı. Histolojik tanı, ektopik paratiroid adenomu olduğunu doğruladı. Özellikle rekürren paratiroid adenomlarının eksizyonu sırasında gamma prob kullanımı, hem operasyon süresini kısaltması hem de gereksiz boyun diseksiyonunu önlemesi açısından önemlidir. Nadiren görülse de, gamma prob ile aktivite tutulumu, timus dokusu içerisinde de araştırılmalıdır.Öğe Use of the right lobe graft with double hepatic arteries in living donor liver transplant(Experimental and Clinical Transplantation, 2016) Çakır, Tuğrul; Sabuncuoğlu, Mehmet Zafer; Soyer, Vural; Sarıcı, Kemal Barış; Koç, Süleyman; Onur, Asım; Ünal, Bülent; Akbulut, Ahmet Sami; Yılmaz, SezaiObjectives: We aimed to examine management of double hepatic artery reconstruction in patients under going living-donor liver transplant. Materials and Methods: Between January 2002 and June 2014, one thousand thirty-six living-donor liver transplants were performed at the Liver Transplant Institute of Malatya Inonu University. Living liver grafts with a single hepatic artery were used in 983 living-donor liver transplants, while grafts with double hepatic artery branches were used in 53 livingdonor liver transplants. All of the liver grafts with double hepatic artery branches were right lobe grafts. Hepatic artery anastomosis technique and the other medical data of recipients who used grafts with double hepatic arteries were analyzed retrospectively. Results: A double hepatic artery anastomosis was created in 43 recipients, while a single anastomosis was created in the remaining 10 because of ligation of the nondominant hepatic artery branch. In 40 recipients, double hepatic artery branches in the graft were anastomosed with the recipient’s right and left hepatic artery. In the remaining 3 recipients, double hepatic artery branches in the graft were anastomosed with the recipient’s right hepatic artery and large segment 4 hepatic arteries. Postoperative complications related with hepatic artery anastomoses developed in 3 recipients: hepatic artery thrombosis (n = 1), hepatic artery aneurysm (n = 1), and hepatic artery stenosis (n = 1). A recipient with hepatic artery aneurysm immediately underwent a retransplant. A recipient with a hepatic artery thrombosis relapsed and required retransplant, which was treated with thrombectomy on postoperative day 10. A recipient with hepatic artery stenosis was followed conservatively. In our series, the incidence of complications related with double hepatic artery anastomosis was found to be 6.9%. Conclusions: According to our experiences, a double hepatic artery anastomosis does not increase the risk of hepatic artery thrombosis and can be performed safely by surgeons who are experienced with hepatic vascular reconstructions in a living-donor liver transplant recipient.
